Chen Shu-Wen
PhD, RN, Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC.
Hu Li Za Zhi. 2016 Oct;63(5):44-54. doi: 10.6224/JN.63.5.44.
Repeat caesarean delivery (RCD) ranks as the top reason for the high caesarean rates in Taiwan. More than 90% of Taiwanese women who have had a previous caesarean delivery chose RCD following their next pregnancy.
To explore the decision-making processes regarding RCD in Taiwanese women.
A qualitative approach with grounded theory was used to conduct this research. Participants were recruited from a private medical centre in northern Taiwan. Methods of data collection include in-depth interviews, observation, and field notes. Constant comparative analytical techniques were employed for data analysis.
A total of 16 women chose RCD. Ensuring the well-being of mother and fetus was the core theme. Women's decisions were influenced by both internal factors (previous negative experience of birth, concern about uterine rupture, fixing the scar of previous caesarean and current pregnancy situation) and external factors (obstetrician's recommendation, the experience of female significant others, an inaccurate information from internet and the unconditional financial coverage from Health National Insurance). Decision-making processes involved searching information regarding mode of birth, evaluating vaginal birth risk, trusting obstetricians' professional judgment, and a lack of progress during the course of labour.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The well-being of mother and fetus is the major concern affecting mothers' decisions regarding RCD. The majority of Taiwanese women participate passively in the decision-making process regarding their options for mode of birth. In the present study, women choices were primarily guided by reducing the risk of uterine rupture. Hospitals should reduce unnecessary induction interventions. Obstetricians should inform women of the risks and benefits of various birth modes. The government could establish a website that provides a clear explanation of the criteria for the government to financially cover the costs of RCD in order to assist women to make optimal birth choices.
在台湾，再次剖宫产（RCD）是剖宫产率居高不下的首要原因。超过90%曾有过剖宫产经历的台湾女性在下次怀孕后选择再次剖宫产。
探讨台湾女性关于再次剖宫产的决策过程。
采用扎根理论的定性研究方法进行此项研究。研究对象从台湾北部一家私立医疗中心招募。数据收集方法包括深入访谈、观察和实地记录。数据分析采用持续比较分析技术。
共有16名女性选择再次剖宫产。确保母婴安全是核心主题。女性的决策受到内部因素（既往不良分娩经历、对子宫破裂的担忧、修复既往剖宫产疤痕及当前妊娠情况）和外部因素（产科医生的建议、重要女性他人的经历、来自互联网的不准确信息以及全民健康保险的无条件费用覆盖）的影响。决策过程包括搜索有关分娩方式的信息、评估阴道分娩风险、信任产科医生的专业判断以及产程中进展不顺。
结论/实践启示：母婴安全是影响母亲关于再次剖宫产决策的主要因素。大多数台湾女性在分娩方式选择的决策过程中较为被动。在本研究中，女性的选择主要以降低子宫破裂风险为导向。医院应减少不必要的引产干预。产科医生应告知女性各种分娩方式的风险和益处。政府可设立一个网站，清晰解释政府为再次剖宫产费用提供财政覆盖的标准，以协助女性做出最佳分娩选择。
